Clinical outcomes and dialysis adequacy in adolescent hemodialysis patients

Background: The National Kidney Foundation-Kidney Disease Outcomes Quality Initiative guidelines recommend that adult hemodialysis (HD) patients receive a minimum dialysis dose by single-pooled Kt/V (spKtfV) of 1.2 or greater. There are no data to support a minimum spKt/V dose for children on HD therapy. We aim to determine the association of spKt/V with mortality and hospitalization in adolescents. Methods: Clinical characteristics of adolescent HD patients aged 12 to 18 years old included in the 2000/2001 End-Stage Renal Disease Clinical Performance Measures Project were linked to US Renal Data System data from October 1, 1999, to October 15, 2001. Hospitalization risks after adjustment for time on dialysis therapy, access, hemoglobin level, albumin level, and height were determined by means of Poisson regression. spKtfV was analyzed by the adult target (< versus >= 1.2) and by intervals. Results: There were 613 patients with 477 patient-years of follow-up, during which there were 14 deaths and 185 hospitalizations covering 1,108 days. After adjustment, patients with an spKtfV less than 1.2 had increased hospitalization risk (1.59; 95% confidence interval, 0.98 to 2.56; P = 0.06) compared with those with an spKt/V of 1.2 or greater. Compared with patients with an spKt/V of 1.2 to 1.4, patients with an spKt/V less than 1.2 had increased adjusted risk for hospitalization (2.46; 95% confidence interval, 1.23 to 4.94; P = 0.01). Increases in spKt/V beyond 1.4 were not associated with improved outcomes. Conclusion: Applying the current adequacy guideline to adolescent HD patients is justified by the increased hospitalization risk of those who fall to attain an spKt/V of 1.2 or greater. However, attaining an spKtfV in excess of 1.4 was not associated with greater benefit.